In the golden age
of Islamic civilization, Muslim scientists contributed to sciences
such as chemistry, biology, mathematics and medicine. Allergy
or sensitivity which is called a modern disease was original described
by one of the outstanding Iranian physicians nearly 1000 years
ago - Mohammed bin Zakariya
al-Razi.

Al-Razi was born in 865 AD in Ray, south of Tehran, which
is now a suburb of Tehran in Islamic Republic of Iran. He studied
music, literature, philosophy and chemistry in the city of his
birth and only studied medicine relatively late when he was
30 years old. He was asked to run a hospital in Ray and later
on in Baghdad. He was renowned as an acute clinical observer.
In this later years he became blind and died in 925 AD.

Razi achieved fame in the later part of the first
millennium because of his authorship of the Alhawi Book, latinized
as Liber Continens as well as the ninth book of Ketab of Mansori,
latinized as Nonus Almansoris in which he specifically discusses
what we would now call clinical pathology. He also described smallpox
and measles in his treatise De variolis et Morbillus.

His interest in what we now know as hay fever
and catarrh was stimulated by the symptoms of his philosophy teacher,
Abi-Zaid Ahmad bin Sahl Al-Balkhi, who suffered sinus pain and
catarrhal inflammation every year during the `time of the flowering'.
This report was not published separately but was mentioned by
Ben Sharabeyun ben Ibrahim in his unique book Alfosool Al-Mohimah
Fee Tib Al-Umah (Important Chapters in Public Medicine) (Figure
1). The report by Razi is the Codex Huntingdonianus 461 (foll.
78b3-80b8) in the Bodleian Library in Oxford.

The book Kitab Alfosool Al-Mohi-mah Fee Tib Al-Umah, (Important
Chapters in Public Medicine) is a compendium in 43 sections containing
extracts from al-Razi, Ibn Sina, also known as Avicenna, [folios
91a-118a], Rufus of Ephesus [folios 38b-5a] and Hunayn ibn Ishaq
[folios 52b-63a]. There is only one incomplete copy of this book
extant, and its exact date of publication is not known. Since
Bin Sharabeyun ben Ibrahim referred to Avicenna (Abu Ali-Sina
died in 1037 AD), the date is thought to be in the first half
of the 11th century.

Razi wrote one of the chapters of this book about allergic symptoms.
Razi clearly relates the symptoms to flowers and a particular
time of year. He also suggests some non-pharmacological treatments
for the condition, which may have helped his teacher during the
pollen season, but these may not be so acceptable to the modern
sufferer.

Seasonal allergic rhinitis (hay fever) is considered
a disease of the post-industrial revolution era. Clinical reports
of patients are readily available from the 19th century starting
with John Bostock's description of his own summer symptoms. Also
patients with `rose catarrh' are described in the 16th and 17th
century. Prevention and treatment of hay fever were rare in the
first millennium:

1565

The best-known early reference is to Botallus
who noticed that headache, sneezing and itching of the nostrils
could be set up by the odour of roses.

1691

De Rebecque describes his own hay fever, which
consisted of symptoms of a cold during the summer months,
specifically during the rose season.

1695

Riedlin who de-scribes one of his friends with
`coryza a rosarum odore'again linking hay fever with roses.

1819

John Bostock who describes his own symptoms
of seasonal allergic.

1873

The actual cause of the seasonal symptoms was
later elucidated by Blackley.

It is Razi who we think was the first to describe
the treatment of hay fever in its full clinical form and suggest
remedies (prior to 925 AD) almost nine hundred years before Bostock,
having been prompted by the symptoms of his philosophy teacher.

Razi's paper

Al-Shahid bin al-Hossein al-Balkhi wrote a letter
to Razi (865-925 AD) asking about the reason of the illness of Abu-Zeid
bin Ahmad bin Sahl al-Balkhi al-Katib. Razi replied to him:

'In the name of God, the Beneficient, the Merciful"

`I understood all that you asked about his illness, as to the cause
of the disease and why it becomes worse during pollinisation (Spring
season) when the smell Of flowers' amplifies the illness. So I shall
concentrate on the prophylaxis and treatment of the disease very
briefly (Figure 2).

Figure 2: This is a portion of the
original Arabic manuscript of Razi written ca. 925 AD. The first
part implied an understanding of hay fever one thousand years ago.
`In the name of God, the beneflcient, the merciful. Al-Shahid ben
al-Hossein al-Balkhi wrote a letter to Razi (865-925 AD) asking
about the reason of the illness of Abo-Zeid ben Ahmad ben Sahl al-Balkhi
al-Katib. Razi replied to him: `1 understood all that you asked
about his illness, as to the cause of the disease and why it becomes
worse during pollinisation (Spring season) when the smell of flowers
amplifies the illness. So I shall concentrate on the prophylaxis
and treatment of the disease very briefly'. The complete manuscript
was translated into English from the original Arabic text for the
first time by G.A. Bungy et al.

Prophylaxis

It may be useful to avoid heavy meals that give a feeling of
fullness arid drowsiness.

DO not sleep immediately after dinner especially of ter drinking
a large amount of cold water.

Avoid living in damp and humid places, for example jai Is,
tunnels Or damp houses.

Do not expose the patient's head to cold weather espedal ly
after catching a cold.

Do not eat food or drink water excessively and do not speak
or exhaust yourself with excessive thinking.

Do not fasten your neck button tightly.

Avoid cold showers or submerging your head in cold water. Try
to keep the hair short.

Do not smell strong perfume especially when orig-mating from,
e.g. flowers and Shahsafarm which are very pleasant, attractive
and beautiful.

Do not smell anything which causes sneezing when the abdomen
is full'.

Do not eat anything which may cause sleep such as saffron,
mandrake (Loffah), storax (Mai ah).

Do not eat foods which are hard to digest such as peas, fish,
chicken, onion, thyme (Korath), garlic, ginger and wine.

Try to lose more weight in the first and middle of the Spring
season, try to use agents which are able to remove perspiration
(sweating) accumulated inside the body due to:(a) overconsumption of foods and drinks; (b) oversleeping in houses full of heavy air, too much
steam or smoke, as heaviness of the evaporated materials ascend
towards the head.

Do not sleep on your back, but try to use the sneezing stimulants
by applying some wheat powder to the pa-tient's nose to bring
the mucous fluid from the lung to the nose to get rid of it.

Treatment

Clean the running nose frequently. Dissolve some
material like camomile, a special type of dessert plant or mentha
sativa (Nammam), madder (Fotanj), wormwood plant (Shih), etc. in
hot water and breathe their vapours before sleeping which prevents
material falling to the chest at the time of deep sleep. This happens
especially when one lays down on ones back for a long time. It may
cause coughing, tightness of breathing and breathlessness (wheezing),
and high body temperature (fever). Meanwhile it should be necessary
to take into consideration to dissolve the materials entering into
the chest using some dissolving material such as honeydew melon
to clean and clear the chest easily and prevent the mucous material
from affecting the lung. At the same time, these dissolving drugs
will prevent the mucous that was in the nasal area from going inside
the chest. If there is too much pressure on the nasal area, the
hair of the head should be cut and covered with mustard. Hot materials
such as coriander (ash-shonise), onions and mustard should be smelled
to create sneezing. The things that strengthen the throat muscle
such as cold water are also useful with frequent washing of throat
with constant or regular drinking that prevent mucous falling into
the chest.

Do not use drinks such as opium liquid or poppy juice (Sharab al-khashkhash),
or any drugs and extracted liquid originating from opium or poppy,
tragacanth (al-kethira), gum (Samgh), the mucilage of pear seed
or the saliva of quince seeds (Lo-abe Habbe Safarjal), Al bazraghatoona,
purslane juice (baghlato al-hamgha) or night shade (enab Ath-thalab).
If the patient is in trouble due to coughing, using medicines coming
from opium-like materials such as morphine, hashish, frankincense
(Kondor) and Armenian mud are useful. Massage of the chest will
help to moisten the materials inside the chest with oils from plant-like
material (Ghyroti) coming from cactus (Khiry) oil or camomile oil
and keep the chest warm with hot clothes. Staying in a big house
which is protected from cold weather and facing steam from boiling
water or a bath with great amounts of steam which encourage the
removal of mucous. To dissolve the mucous materials, strengthen
the body activity together with the use of medicines such as barley
water or a decoc- silver knife is also suggested. More than one
patient has tion of water with sugar and honey, cooked figs and
raisin, been cured by cutting the blood vessels on the side of foreliquorice
(Asl As sons) itself, maidenhair (Par-e-siawoshan) head. This vessel
and also other local vessels in the forehead and continuous use
of hot water to wash the throat is neces- which are in contact with
the bone are not overfull of blood. sary. If the case is more serious,
medicine which is extracted The face becomes warmer due to the blood
circulation in the from fenugreed (Trigonella foenum-graecum) (Holbah),
vessels.

For that group of patients who have got a warm and true horehound
or motherwort or marrubium (Farasiion), red face (but excluding
the others mentioned above) cutting fig, special date (Earesa),
pepper and mustard is good to be the ear for bleeding is more useful.
Also eating everything used. If a patient suffers from this disease
due to running of which can keep the blood cold and more concentrated
is the nose and itching, and a lot of sneezing, he can also use
useful. For example, lintus, sour grapes and rhubarb or sorthose
medicines which are mentioned above. Furthennore, rel (Rybus). Sometimes
patients should keep their heads walking and being in the bath till
sweating is also suggested. cold with vinegar and flower oil which
is cool upon their use Bleeding by making a small hole in the patients
back using a as a piece of ice. This has been tried on the head
of a man who was drunk so he suddenly screamed loudly and then became
calm. What he felt was a severe cold which entered his head deeply.
Then he had a simple cold for one night. This was not a successful
treatment for other such patients who were treated similarly by
this method not only once but several times. However, severe diarrhoea,
walking and fasting were very useful for him.

For those who have a big neck vessel and those who suffer from smelling
flowers, it is useful to smell musk, Ele cam pane (Ghost) and colocynth
(almor). It is useful to clean inside the nose by inhalation of
the lily of the valley (Sown) and frankincense olibanum (Ban).

Thanks to God who is the Just One, and blessings upon prophet Mohammad
(peace be upon him) who is the best creation of God and also upon
his family and companions, many greetings.

The above article is an adaptation of a summary
by Shekoufeh Narmizadeh based on a paper by Dr. Bungy et al published
in:
International Archive of Allergy and Immunology
July 1996
Volume 110
Page 219-224